The key thing about long acting reversible contraception methods is that they are all “fit and forget” methods; this means once they are fitted or given, women are protected from pregnancy without having to do or think anything about it, until it needs replacing.

In the UK the contraception injection is Depo-Provera and it lasts for 12 weeks. There is another one called Noristerat that lasts for 8 weeks, but that is rarely used or available now.

“If used correctly, the contraceptive injection is more than 99% effective. This means that less than one woman in 100 who use the injection will become pregnant in a year”- NHS Choices 2015

The injection contains progesterone. This stops ovulation ( the release of an egg every month), thickens the mucus in the cervix (stopping sperm reaching an egg), and thins the womb lining.

Chloe works with young people with complex and special educational needs and lives at home with her mother and younger sister. Ethnic background' mixed other.

At your, you first get it done at your, well I did at my doctors by the nurse and yeah, you’d have to do different health checks, they would check your weight, your blood pressure, things like that and say you’d get it done either in your arm or in your bum or wherever there’s enough flesh for it because it’s quite a big needle and then you’re advised still not to have unprotected sex for a week after that and then, so they’d give you, and then when you get it done, they give you an a date for your next appointment which is usually; the injection lasts for twelve weeks but it’s usually at ten or eleven weeks your next date so that you’re, you’ve got enough time to arrange it without having a gap because then you have to do a pregnancy test and stuff if you have a gap, then you’re not, they assume you might not have been protected in that time so you have to overlap it and then when you go back, they do the same thing again, they do the different health checks, the blood pressure weight and stuff and just get the same thing done again.

I discussed it with my Mum and she thought it would be best as well to go on that because she knew that I didn’t take my pill and she didn’t want to be a Nan [laughs] with me that age so, yes she was fine with it as well.

And how did you feel in yourself when you started on the injection?

I was quite OK with it, I quite like, as I said, enjoyed the fact that I didn’t have to have periods and stuff like that although sometimes you did get like a bit emotional and stuff when you would have been due to come on but you just didn’t have the period or the pains and…

It did hurt actually for, it hurts the actual injection cos it’s quite a thick liquid and you can feel it being pushed in and then like if they overdo it, and cos I was so slim, I had to have it in my bum, in, cos that was there where there was enough fat, cos they didn’t like doing it in my arms cos I was so skinny. I did have it in my arms a couple of times and it really aches like for the next day, it’s really painful. It feels like someone’s just kicked you in your bum and something but other than that, I was fine with it.

OK so the actual injection hurt?

Yeah it actually hurts yeah and cos the liquid is thick. It’s a big needle and the liquid is thick so you can feel the liquid going in and then it’s, it’s painful afterwards like a bruise but more painful than a bruise actually. Yeah

And for how long does the pain last?

A day or a day and a half or two.

One of the main advantages of injections is that women don't have to worry about remembering to take anything, so they are good method for people who are a bit forgetful. It is important to remember that the LARCs do not offer any protection against sexually transmitted infections. If there is any possibility of infection, condoms should be used as well.

She is married with a small child and works full time. Her husband also works full-time and her in-laws help to take care of their child. (Played by an actor)

(The accompanying video and audio clips are played by an actor)

You said you had some information about sexual health for instance about safe sex, prevention of unwanted pregnancies, sexually transmitted infections?

I think infections aren't so, I mean pregnancy is a bigger worry than infections to a lot of teenagers and that's something that's not so widely spoken about, for me anyway.

When I was a teenager I think that pregnancy was the main issue rather than infections and I found myself with an infection once and I had to go and sort it out and I didn't really have a lot of support from you know, people to talk to, I didn't talk to my peers about it.

I felt like I'd been an idiot and it was just stupid of me for being lax you know, and since I've made sure that you know, there's absolutely no contact before the condom went on you know because you think well, the most important thing is to make sure that he doesn't ejaculate you know what I mean, and you can have as much contact then, and that's something I think that I wasn't really aware of as much, I was more concerned about not getting pregnant, you know at that stage, and then after that things changed.

There can be many reasons for a woman to choose a LARC method, including concerns about side effects of other methods, wanting to stop using condoms, having trouble remembering to take the pill, concerns about the effectiveness of the pill when sick, irregular painful periods and bleeding or to reduce the risk of pregnancy. People may want to change because they have had problems with other methods.

Works as a production assistant, lives with partner and she is looking for an alternative method of contraception to the implant.

When I turned, it must have been about 14 or 15 and I was very young I started with very, very painful periods. And they tried numerous methods to try and help me. First of all painkillers and finally they switched to trying me with the pill because they thought that would help. And what I found was that it was making me ill at night. So eventually at the age of 14, 15 they put me on the depo [Depo-Provera] injection which wasn’t widely spoken about when I was younger and not a lot of research had been done for it.

It was only when I turned 18 that research came out that suggested you might be susceptible to osteoporosis if you have it before 17. So that made me feel a bit nervous but I have to say I loved the injection because it stopped my periods completely which as a girl and anyone can relate to, it was great.

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Age at interview:

18

Sex:

Female

Background:

Full time university student, single. Her top priority at the moment is to avoid an unwanted pregnancy. Ethnic background' Mixed Race.

Well I know that when I drink alcohol and as a university student I drink a lot of alcohol and I know that when I go out and when I do drink and get drunk I will get forgetful and I will forget to take my pill if I took my pill in the evenings because I try and take them at the same time every day. And if I take my pill in the evenings and then I go out and get drunk what often happens is that I’ll get very drunk and I’ll end up being sick. And then I don’t think if it happens quick enough I was told that I wouldn’t have time to absorb the pill. So it would be as if I hadn’t taken it at all. So this was, this was a major concern of mine just in terms of if I drink alcohol and I do get sick will the pill still work but if it’s not fully in my system.

Some of the women interviewed chose to use injections as their method of contraception after trying the pill or condoms.

Bangladeshi woman who lives on her own. She left home at the age of fifteen and was in the care of social services. At the time of the interview she was a full-time student. (Played by an actor)

(The accompanying video and audio clips are played by an actor)

You were sort of not using condoms or anything?

No I wasn't. I just had unprotected sex every now and again but it was with the same guy because I was still with him, but then we got a bit worried and I'm thinking oh no, what if I fall pregnant, what am I gonna do then. So that's when I went to the doctor and said 'Look seriously I need something.'

Because I kept on going for the morning after pill. Most of the time I went for the morning after pill and they'd say "the morning after pill's not really good, you're not supposed to really take it more than three times in a year", and I did take it more than three times in a year, you know what I mean' Yeah seriously, I did.

That's when they said to me you know 'You seriously need to think about long term, contraception'. So then yeah that's when Depo came in to it.

Because like my GP, I've known her for a long time and she's been my childhood GP, she knew when I left home and everything so she knew she has to be there as an extra support for me as well to explain everything to me.

And then obviously you go to see the nurse for contraception and things like that, so she transferred me to a nurse who explained all the procedure to me.

So like if I had a problem the first person I would go and see would be my GP because I can really, really trust her, she's like a friend to me, someone I can really openly talk to, so that's nice.

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Age at interview:

25

Sex:

Female

Background:

Works full time as an account manager lives with her fianc'e and they are getting married next year. She wants to have children soon after that.

I had erratic bleeding with the mini-pill quite severely, and I went back and discussed my options with them. And I decided upon the contraceptive injection because that, it kind of seemed the only possibility that was suited to me and basically what I needed and what I felt comfortable with. So I went on the injection when I was 18.

Okay, and how long did you keep using the injection?

I'm still on the injection now.

So you have been for 5 years?

Yes, 5 years is a long time, a long time.

Any problems?

I'm extremely happy with the injection, extremely happy. I've had no headaches, no major problems.

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Age at interview:

23

Sex:

Female

Background:

Holds a science degree and works full time. At time of interview she has been in a long-standing relationship for the past five years. (Played by an actor)

(The accompanying video and audio clips are played by an actor)

Well I got it from my family planning clinic, basically they gave it to me because I was suffering really badly from thrush and whatever I did I just couldn't get rid of it. The doctor said that she had some success giving people Depo Provera to get rid of thrush and you know, she said I could try it, thankfully it did work, you know, it was great, it stopped me having periods as well which I was quite keen on.

What I thought was quite interesting was alot of my friends thought it was silly not knowing when you're getting your period, because you couldn't be sure you weren't pregnant, but I quite liked it.

Do you feel that you have had sufficient information about contraception and at the right time for you?

Yeah , I mean I don't think I was ever left in the dark about it, I mean you do kind of learn things, don't you, but I didn't know about this Depo Provera, but if I had, I would probably gone and got changed onto that sooner

Well I mean if I'd known about Depo Provera I would of gone sooner to the family planning clinic but it's not really well known is it. I mean I don't think people know it can help with thrush, I would of gone sooner if I'd of known.

Before changing contraception methods there are leaflets to read about what's available or health professionals to talk to at GP surgeries, Family Planning or Brook clinics. Remember, implants and injections do not suit everyone.

Women we spoke to had different experiences of contraceptive injections and, while women often reported being happy with the injection, some stopped taking it because of health concerns. Some used injections as contraception after childbirth. Although one woman thought two weeks after having her baby was too soon for an injection, it is safe to have the injection immediately after giving birth - if not breastfeeding. If breastfeeding, then it is an option six weeks or more after birth.

Final year at University. She is in a serious relationship, and she and her partner agreed to go for STI testing before stopping using condoms. (Played by an actor)

(The accompanying video and audio clips are played by an actor)

My moods are a lot better. I used to get quite depressed quite frequently, not like seriously depressed or anything but I used to feel low, quite a lot of the time. And I used to be a lot more concerned about my body shape and I'd get a lot of sort of water bloating coming up to my period.

And now that I'm on this injection and my hormone levels are straight, I don't get any of that. And I feel, I mean around the time when I would have been having my period I sleep a lot better and I don't get these irrational mood swings and I just think it's fantastic. I haven't, the only thing I've noticed, when I was on Dianette that's the one that's supposed to be good for your skin isn't it?

I was on that one a bit before I changed over so I noticed a bit of a change in my skin for the first couple of months when obviously the Dianette wore off. But it's settled down now and my weight's a lot more stable.

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Age at interview:

25

Sex:

Female

Background:

Single professional woman who works full time in the managerial sector. Brought up in a rural community where women had no access to family planning services.

I'd always had periods every two months or thereabouts, sometimes three, and they lasted about two weeks when I did get them, anything for a month to three months apart.

Then I went on the Pill and obviously they were regular then but I kept forgetting to take the Pill so I stopped doing that and they carried on being irregular for years and years and years, and then when I started Uni I tried the injection and that made things even worse.

Which one, Depo Provera?

Yes Depo Provera, and that made things even worse and I've just put up with it for the last ten years and it was only last year that I actually went to see a homeopath and actually she sorted it out.

Then I came off it completely, I wasn't on the Pill or anything and I just carried on using condoms and then I went on the Depo when I was twenty.

For how long?

That was for a year and I was still bleeding even when I was on the Depo so it wasn't right for me at all so I came off that and then I just said 'no more' hormones and stopped.

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Profile Info

Age at interview:

25

Sex:

Female

Background:

Works full time as an account manager lives with her fianc'e and they are getting married next year. She wants to have children soon after that.

I did experience before Christmas some problems with stomach pain and erratic bleeding and I went back to the clinic and explained this to them and they said have I got a new partner? And I was like, well no I've been with my fiance for about year so they were quite happy and '

They changed my injection, I went on the progesterone only injection. So I used to be on Depo and now I'm on Noristerat and '

Okay, and how long have you been on the new one?

I've been on the new one now, they put me on that shortly after I went back to the Family Planning clinic with my clear results. I went back and they suggested that I go on to the Noristerat so it's been for about 4 months now.

The majority of women will have less frequent bleeding or none at all when using the contraception injection. A few women get frequent or heavy bleeding especially with the first injections. This usually settles down but if it doesn’t, it is advisable to talk to a doctor or nurse.

We talked to women who had stopped using LARC and started using other methods such as one of the contraceptive pills, and they said that they find it difficult to remember taking it every day. Stefanie has an alarm on her phone to remind her to take her pills and keeps them next to her toothbrush.

We also spoke to women who decided to stop using LARC or had never used LARC. They had a number of reasons for their decision including: experiences of relatives or friends, ‘horror’ stories reported by the media, concerns about LARCs' impact on fertility, possible link between long term use of Depo-Provera and osteoporosis (fragile bones) and also the perception of losing control over their own bodies.

Works as a production assistant, lives with partner and she is looking for an alternative method of contraception to the implant.

Do you have any health concerns about injections or the implant or? Because you talk about hormones and chemicals?

I didn’t until I read the report about osteoporosis and it specifically said “people that were”. There have been. I mean there’s no real proof but it said that people who should be most wary are anyone on it for a long period of time and anyone who is given it before the age of 18. So of course I come into both of those categories. So that did make me nervous. And I spoke to one of the doctors about it and she said, “Oh it will be fine. Just drink more milk. You’ll be fine.” I don’t know how scientific that is but it did make me feel a little bit nervous about.

Do you think that you have been given enough information?

I wasn’t regarding osteoporosis. I don’t know if that was a study that came out afterwards. It’s more than likely. So I hope that they do tell more people about it. I would like to have known about it before. And regards to side effects I was given reading material. I don’t necessarily think that’s a good idea. I don’t know about. I don’t want to generalise but I know when I was 16, 17 I didn’t really read anything I was given flyer-wise because you can be swamped in that kind of stuff.

So what do you think is going to be the best way to give a young teenage this type of information? What would have worked for you?

Just I think verbally when I was younger would have worked. Nowadays I like to find out for myself on the Internet but I can’t imagine many people and not everyone would have. People like to just be spoon fed and not really think about it. I know that’s what I was like. But flyers for me just didn’t. They just went straight in the bin and I never really properly read them.

Ok and did you find out this information about the possible kind of relationship between long term use of the injection and osteoporosis or it was raised by a doctor?

Actually now you mention it I think because that’s a good point I don’t know why I would have suddenly found this out. And I think that it might be because my doctor’s sent me a letter. I think they went through their records of everyone who had been on the injection and notified them, if I think that’s what happened. And of course I got the letter and I was I don’t know if they had to do it to everyone who they gave the injection to but I imagine then if people were at clinics where they might not have received that kind of information. I don’t know how it works but my doctor would have had my proper address on the records so they sent me a letter.

And following that you went to try and get more information from a GP.

Uh huh.

So how did you feel about the fact that she said that you would be ok, drink more milk?

It was what I wanted to hear. She said that, “It’s not proven. I’ll be fine.” And she dumbed it down. So at the time I felt better because I thought, ‘Well she’s a doctor she knows’. But now I probably would have liked to have been given more information so I could have decided then because I carried on with the injection for a few years after that. So it maybe would have been better if she had been a little bit more up front which she obviously personally didn’t think much of the research itself. But inflicting your personal opinion on someone as influential as I was probably is not the best thing to do.

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Age at interview:

21

Sex:

Female

Background:

Chloe works with young people with complex and special educational needs and lives at home with her mother and younger sister. Ethnic background' mixed other.

You started thinking about it after that incident with your sister?

Yeah, I started thinking about coming off the injection when my elder sister who had been on it for twelve, eleven/twelve years had started to having problems and she had low oestrogen levels which was due to the injection. I don’t know the ins and outs of it and then, so she had to come off of that and she had to get injections of oestrogen I think as far as I’m aware and then she had to go on the pill and then come off of it because she was trying for a baby but I think that she had to have the other injection before, like before she could, to enhance her chances of having a baby. I’m not too sure, that’s what I kind of put together in my head.

So, what were your worries at that time?

I was worried that because obviously you don’t have periods and you’re supposed to have one every month, that maybe it was doing something to my insides and I, maybe there would be a possibility that I couldn’t have children and cos I’d been on it from when I was very young and throughout my key developmental stages, I was quite worried about that and I was convinced that it was stopping my breasts growing. I don’t know whether it was because I was so skinny as well but that’s something that I was paranoid about and I also did put on weight after I’d come off of it and they did grow so I don’t know whether it’s linked or not, so.

No you don’t speak to the doctor to come off of it all, most of it is done through the nurse and she deals with the contraception and stuff like that. And there’s not really a big discussion or consultation around coming off of it. I was just set that I wanted to come off of it and I said, “I want to come off it and start going on the pill,” and that was that I think. And so I didn’t get my next injection and got the pill and the right time to get it, you know, yeah.

OK, so you were having the injections every twelve weeks?

Yeah

OK. So by the date that you were supposed to have your next injection, you started your pill or you started before?

No, I no, I didn’t, I had a period and then started the pill.

OK

Yeah

And you had to use other form of contraception during that period?

No at that time I wasn’t sexually active, yeah.

OK but what did the nurse advice regarding protection?

The nurse advised that if I was to be sexually active to use condoms and yeah at that time they did advise about condoms because obviously contraception doesn’t protect you against different sexual infections and stuff. So I think around that time, I did have a conversation with my nurse about different contraception and stuff like that.

So how, how was the experience of getting your periods back? Were you sort of having painful periods or not?

At first when I first started to having periods, they was irregular, I couldn’t predict when they was going to come, sometimes there was spotting, sometimes there was heavy and then after about three months, they became more regular and then they wasn’t painful at first, I liked it, it was kind of a warming kind of comforting thing to have them and to have them regular and to think, a kind of a reassurance that, “OK your reproductive system is in working order,” kind of

The injection is linked with a small loss of bone density, which usually goes back to normal after stopping the injection. There is no available evidence on the effect of long term injection use on the risk of breaking bones. When considering options, other factors that can reduce the density of bones may be taken into account (such as weight, smoking, other medical conditions, and a family history of osteoporosis).

When injections are stopped, there can be a delay in returning to regular periods and fertility for up to a year. There is no evidence they reduce fertility in the long term.

Women we interviewed commented that the amount of information they got from their GPs regarding LARC was variable and that, often, they were given leaflets to read rather than the time to talk about the different options available to them.

Katie
University student; single. At the time of the interview she was living in an all female student house. Ethnic background: White British.
Alice
Final year at university; single. Shares a house with other students.
Ethnic background: White British.

Katie' I can’t say that they really discussed it with me. I was given a bunch of leaflets and told to go off and maybe if I want, you know, if I wanted to talk about it more then come back. Well, I think I would have preferred them to have gone through each method and actually told me, you know, what they thought that the pros and cons because I’m not a doctor and I don’t know exactly.

So in the end I just decided to stay with the pill but I would have preferred maybe to talk about it a bit more with them.

So, not enough information and advice has been given to you?

Katie' No, I just had the leaflets and that was it and I would feel more reassured if I had actually been able to speak to them personally, you know, to their face rather than just reading the leaflets by myself.

Because it’s confusing with all these?

Katie' Yeah.

Different methods, yeah, and in your case.

Katie' I was actually it sort of had an explanation on the implant and the coil and, and that sort of thing but, at that stage, I felt that sort of the contraceptive pill was all I really sort of wanted to look at and everything else seemed a little bit more permanent especially because at the time I was only taking it for sort of period reasons rather than contraceptive reasons.

Katie' I would have preferred to have discussed it more. I found like the doctor was trying to rush me out, giving me leaflets. So I would have preferred to have spent more time with them but, yeah.

Alice' I, well, I don’t agree with that only because I had a very different experience in my doctor was incredibly helpful and sort of every time I’ve been back in to get a repeat prescription they always sort of check that I’m okay with the contraception I’m on. And they do mention the alternatives to sort of warn me and stuff so I’ve I think I’ve had quite a different experience.

Katie' It depends, doesn’t it, on the doctor.

Alice' Yeah, I’ve always felt like my doctor has sort of had time to talk to me about it.

The young women we talked to advised others to get as much information as they could find about long acting reversible contraception and other forms of contraceptives before deciding which one to use. They also reminded people that everyone reacts differently so not to be swayed by the experiences of family members or friends. One of the women we talked to who had used the injection thought that it was better to delay its use until the age of 17 or older and not to use it continuously.

Chloe works with young people with complex and special educational needs and lives at home with her mother and younger sister. Ethnic background' mixed other.

With using the injection as a contraceptive, I would just say make sure that you are comfortable within yourself and you’re doing it for you and you understand the risks. It does have different effects on different people so you can’t go by someone else’s experience to judge whether you want to but if you are to try it, I would say probably have the breaks and not for long periods of time because that’s when obviously the worser side effects are more likely to have an affect but I don’t think it’s a bad form of contraception, in moderation. And for younger women, I think that maybe they should think even more about it especially like how I was fourteen to, in the, like when you’re developing and things like that. I don’t know exactly scientifically if it does have this effect or that effect but just knowing generally that any substance that’s not supposed to be there when you’re developing or have an effect on your body.

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Age at interview:

25

Sex:

Female

Background:

Natasha recently graduated from university and does voluntary work for a charity organization. Single. Ethnic background' Indian

If you decided to become sexually active or if for some reason your doctor said that you need to go on contraception to regulate blood flow or to control your really bad skin or something then ask your doctor for all the potential options. Ask them for all the options that you can have be it the pill, the patch, there’s the injection, the IUD, all of them. Really find out about the options that are available to you because what someone tells you is usually only part of what is out there. And once someone tells you what is out there find out for yourself. Go online because it is completely anonymous. No one is going to know. Find out about these different things. Ask your friends. If you have a sister ask your sister, ask your cousins, you know, but just remember that you’re. I think it’s really hard for girls because you feel like you are alone and you’re not and you’re really, really not because I think there is a certain stigma attached to it if you go on contraception it means, ‘Oh well she is clearly spreading it around isn’t she’. Probably she is not, she’s probably trying to be safe and that is a good thing.

And if you are in a relationship talk to your boyfriend because that’s the person who should be supporting you when you do something like this You know and if you do have a really good stable loving relationship where there is mutual respect and trust have him go to the clinic with you. Have him go through the options with you like saying ‘Well I’m going to get this. Do you feel comfortable with that or would you prefer that I got this or I feel happy with this?’ You know like make it be a really collaborative process about what you are doing because at the end of the day it’s your body but if you are in a relationship with someone, you know.

LARCs are over 99% effective against unwanted pregnancies BUT only condoms or not having sex offers protection against sexually transmitted infections, including HIV.